Provider Demographics
NPI:1083771349
Name:WILLIAM A SPEITEL
Entity Type:Organization
Organization Name:WILLIAM A SPEITEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-641-9880
Mailing Address - Street 1:124 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2810
Mailing Address - Country:US
Mailing Address - Phone:805-641-9880
Mailing Address - Fax:805-641-9890
Practice Address - Street 1:124 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2810
Practice Address - Country:US
Practice Address - Phone:805-641-9880
Practice Address - Fax:805-641-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-05-03
Deactivation Date:2009-10-27
Deactivation Code:
Reactivation Date:2011-05-03
Provider Licenses
StateLicense IDTaxonomies
CAA34840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080010170OtherMEDICARE RAILROAD
CA1710971346OtherNPI
CA1962420752OtherNPI
CA1710971346OtherNPI
CA0271020001Medicare NSC
CAA84702Medicare UPIN
CAW14708Medicare ID - Type Unspecified